Tamoxifen and your liver

Nikisezz

Hi all....I have been on tamoxifen for three years now. Had a bout with endometrial cancer last year, most likely due to the tamoxifen. I now find that my liver is sometimes achy....I don't dare have alcohol. I have just read that there is a connection between long term use of tamoxifen and liver issues. Has anyone else experienced this or heard of it?

Anonymous

Hi Niki, No have never heard of the link between tamoxifen & liver issues.  I know there are cases where tamoxifen causes uterine cancer but of course the oncs say that number is very low.  I have been on tamoxifen five years this coming fall and doc is going to switch me to femara.  I hope I can tolerate it as well as I have the tamox.  What happens when you have a little alcohol?  

elimar86861

Tamoxifen can elevate the triglycerides in the body. Excess
triglycerides can collect in the liver and cause "fatty liver" which,
over time, leads to liver metabolism dysfunction. While Tamoxifen does
this, the main causes are alcohol (drinking it, that is) and metabolic
syndrome (obesity.) If you happen to drink, be overweight, and take
Tamox. -- that's a triple threat as far as developing an enlarged fatty
liver goes.

This does not have to have any symptoms, but it
could feel achy in its enlarged state. Most people don't even know if
they have this. Sometimes the liver enzymes will be elevated on a
metabolic profile blood test. Or if you are getting a CT or other
imaging as part of a follow-up, it might show up there.

The good
news is that the condition can be reversible for most people. Google
fatty liver and you will find information on diets/changes which can aid in
reversing the condition. If the pain is minor, you could easily cut out
alcohol, refined sugars, and carbs for a few weeks and see if your
liver feels any better; and then modify your diet accordingly going on
from there.

If you are really hurting, you should see a doctor
a.s.a.p.; otherwise, do mention it the next time you are in for a
follow-up exam.

Oh, and NO TYLENOL.  That would be the last thing an achy liver needs.

Nikisezz

thanks so much for the information, elimar. This is exactly what must be happening to me. I will definitely cut out alcohol while on tamox just to be safe. I am a normal weight so obesity is not a culprit here.

Shelley56....I am one of the low stastitics...I did get uterine cancer from the tamox....total hysteectomy was performed. Sigh...I swear, the thing that's keeping me alive is also killing me;)

Anonymous

Niki - SO TRUE sometimes the cure can be just as bad as the disease. Now am reading that taking some anti-depressants can prevent tamoxifen from actively working in the body.  I give up. 

rettemich

Shelly, this is true. I was on generic prozac and my MO switched me to Effoxer. Told me that this is the only one that will play nice with the Tamoxifen. Plus it helps with the hot flashes.

Anonymous

Rettemich:  Mine put me on Effexor for the hot flashes but the flashes actually got worse on it.  I also tried Gabapentin, but it was equally ineffective.  I'm glad the effexor helps you.  I'm going to try going back to tai chi a couple of times a week to see if that can help my mood.  

mrskimber47

I too was told I have a fatty liver. This was discovered after the ct/pet scans and before my surgery. After a year on tamoxifen, I have depression and severe bone and joint pain. My onc pressed on my abdomen, on the right side under my rib cage and it hurt like hell. He said he wasn't concerned... How is this not concerning? I had no idea that it was swollen. Since then, it has swelled up even more and I can now feel the enlargement and it bothers me when I roll over in bed, or even bend down...

How on earth does one NOT freak out over every new ache and pain? Anyone have any advice for me, or think I should call my onc and report the new pain? 

elimar86861

mrskimber47,  I don't think any doctor should ignore pain.  Pain is our body's signal that something is wrong.  Yes, you need to report all pain to the MO, and if the MO is not responsive to your concerns then try another doc, like your PCP.  

Like I said, some lifestyle changes can reverse fatty liver, but it also can progress and worsen.  If the liver gets inflamed (and maybe yours is already since it is hurting) it can lead to scarring, which is cirrhosis.  You don't want that, so find a doc who will help you nip this in the bud.

mrskimber47

Thank you elimar. I made some calls today and do have an appt with my PCP, but would have preferred one with my Onc... I found out today via the golden Google search,  that Celebrex, which my Onc prescribed for joint pain for some does cause liver damage. Now, it would have been nice for my Dr. to tell me this prior to my taking it. 

So, I stopped the celebrex, but obviously something else is causing the swelling as well and I'm thinking the Tamoxifen. I won't get any answers tomorrow at my appt, but at the least they can do a liver panel, check my enzymes and maybe an MRI see see the swelling and if their are any lesions. God forbid. I've only been cancer free since last May. I would like to keep it that way. 

Thanks again for the input and I'm going to implement the nutritional changes, just have to do a bit of research and I have to discuss all my meds with the Dr. because no medication is worth liver cirrhosis.  I have been trying to walk and get exercise but I get fatigued so fast these days that my walks don't last very long. 

elimar86861

Unfortunately, so many meds out there are hard on the liver.  I know this thread is about Tamox. and the liver, but if you suspect your liver is doing poorly on Tamox., you really need to take into account all the meds you are taking or have had recently.  Yes, I realize there are some meds we really must stay on; but if a test or scan indicates a bad change in your liver, then it is time to re-evaluate the meds.  You can ask a lot of a healthy liver, but when it is having dysfunction, more care is needed.

mrskimber, Let us know how it goes at your doctor's appt.  I really want to know more about this issue.

edwards750

I have been taking Tamoxifen for 3 1/2 years and I do drink - not often but occasionally. I never heard that about alcohol and Tamoxifen. I do have a blood profile done on my annual visit with my Ob-Gyn so if there are liver issues wouldn't the profile show something as an indicator?

Diane

elimar86861

edwards750, maybe, maybe not.  Many cases of fatty liver are symptomless.  If you are talking about a lower threshold of tolerance for alcohol, I think that is a rare side effect.  If you are talking about fatty liver, then let me clarify.  It is not the Tamox. + alcohol combo that causes fatty liver, per se.  Drinking a lot of alcohol can cause fatty liver by itself.  Having metabolic disorder can also do that.  Thirdly, Tamoxifen can do it too, even in the absence of anything else going on.  The last two examples are "non-alcoholic fatty liver."  My earlier comment was that if you have several of the variables going on at the same time, the chance of having liver disease will increase.  Just think of it as too many straws breaking the camels back (or liver, in this case.)

I'm saying that if you do wind up with a liver issue as a result of the drug treatment (and Tamox. is not the only one) for BC, it is only going to tax your liver more if you add alcohol to the mix.  

Also, consider this, when the liver function is reduced, you cannot metabolise fat calories from your diet properly, which often result in putting on more body weight.  For most of us that means more belly-fat.  Coincidentally, body fat creates its own estrogen...the last thing that any of us ER+ ladies need.  So, Tamox. can end up creating a situation of more estrogen being made, when it's supposed to be in there blocking estrogen receptors.  Kind of a cross purpose, if you ask me.  How many people are affected this way?  I don't know.  It is probably a minority of cases.  You know, like blood clots and endometrial cancer.  

What?  No one told you about the Tamox./liver connection?  Me either.  What else is new?

(Actually, although I took Tamox. for three years, I don't know if it played a part in my own fatty liver.  I think mine was a result of five mos. of chemo.  But that took place after the years of Tamox., so who knows what part Tamox. ultimately played.  Again, how much can one liver take, you know?)

mrskimber47

Elimar; You are so right and pointed out things I didn't even know. What I do know is that a reevaluation is in order on the meds. I am off the celebrex, but the tamoxifen causes ridiculous side effects in addition to the fatty liver problem. But, I would be scared to stop taking it for fear the cancer might come back, but if I keep taking it my liver could go crap the bed and you cannot live without a liver, so what to do?

I do not usually drink, have never been a big drinker and I would say in the last 10 years, I've had drinks maybe twice a year and not very many, so the alcohol has nothing to do with my liver, but the fat stomach is a different story. Since starting TAM I have put on 20 pounds, just in my belly. While I eat healthier and am somewhat active I am gaining weight.

So, you too have a fatty liver. Are you treated for that? I knew about the endometrial cancer so I have an appt for a pap next week. One less thing to worry about.

Side note: I had to see a different doc today as mine was out and I didn't like her. She didn't even feel my swollen abdomen. Just sent me for blood and told me to get an ultrasound. Terrible doctor...But I will have the results tomorrow and the ultra on Mon. I'll keep you posted!

elimar86861

mrskim, It is funny that everyone admits that Tamox. can put weight on people, but they never explained further that it could be an induced liver disease doing it.  Hmmm?  No, a specific treatment was not even mentioned.  I Googled for some diet tips and so I will try to cut my refined sugar and refined carbo intake as well as fats.  I don't have a speck of weight to lose but, hopefully, eating better can't hurt.  I think I have to give my liver time to rebound from the chemo.  The nurse who gave me the "fatty liver" info. seemed to think it would just take time to get back to normal.  So, my liver has about a year to shape up before I get another scan.  

I don't know if there is some "medicine" for fatty liver, but I am one of those that hates to use one medicine for something created by another.  That is why I will just try to baby my liver with a better diet.  I never drank much alcohol.  Now, I will just avoid it altogether.  I'm a little frustrated too because I just read that fructose (fruit) is not good for fatty liver.  Geez, I love all the summer fruits.  Is chemo/cancer taking away yet another thing from my life?  Terrible!

Anyway, FYI, the PAP test is for cervical cancer (slow growning and not nearly as dangerous and not related to BC,) so if you want to be cautious about endometrial cancer while on Tamox., the best way is to have an endometrial biopsy.  The biopsy (uncomfortable pinch for 5 sec.) can be done yearly, or less as you wish.  The second way to monitor the uterus is getting a transvaginal ultrasound (maybe 5-6 minutes of pressure, less than rough sex(*) and if you have had a kid, it's nothing,) which measures the thickening of the uterine lining.  You can get that yearly while on Tamox. or alternate it with the EBx.  The thinking is too much tickening is an overgrowth of cells, which as we know might include cancer cells.  TVU is not conclusive in the way that EBx is, but can be an indication of your uterus going off the rails.

(*)  Not that I'm an expert.  Just spicing up the post, really.

edwards750

Thanks elimar. Great another SE from Tamoxifen. Is there no end to it? I too am afraid NOT to take it though because of the threat of recurrence. I am one of those people too who doesn't want to take something to prevent something else and live with the SEs from either one. I am going to ask my ONC about this when I see her in August. Sometimes I feel like we just can't win...

diane

elimar86861

I second that emotion, edwards750!

Jelson

I too was diagnosed with endometrial cancer most probably due to tamoxifen!! my MO's reaction was "no more blood work for you!" I had had blood work at every 6 month visit because he was monitoring my liver function and without the tamoxifen, then no need!! he also said it would now be easier for me to lose weight. Funny, my belly has got BIGGER after stopping the tamoxifen at the end of 2013. My thought was that my body is compensating for the loss of the tamoxifen-supplied weak estrogen. 

ophelia

Hi ladies,

While searching the web for Tamoxifen as a possible cause of liver disease, I stumbled unto your post and I'm wondering how many women are being diagnosed with fatty liver disease after having been on Tamoxifen.  I was on Tamoxifen for almost 3 years and was never told about the possible side effects. I drank moderately before starting the Tamoxifen and after starting it I would drink only on special occasions, birthdays, anniversaries, etc. Now I'm worried that it might have caused liver disease. 

In 2010 I was told I had elevated liver enzymes.  This was discovered because I was experiencing right side upper quadrant pain that radiated to the back.  An ultrasound was done and it did not show any issues with the liver. The pain and discomfort resolved after several months and the liver enzymes went back to normal. In 2013 the pain returned and continues a year later. The pain is there most of the time it alternates from front to back and sometimes is triggered by found.  I've tried elimination diets and nothing seems to make a difference.  My weight fluctuates and (pardon this) my bowel movements have changed. I've had ultrasounds, MRI, CT Scans and repeated Labs but nothing has been detected. No issues with Gallbladder. My gastro doctor pretty much wrote me off and said it must be IBS.  I don't believe this is IBS as the symptoms don't fit the IBS diagnosis. 

I feel my symptoms are liver related and wonder if anyone else has had similar experience.

Sorry for the long post.

Ophelia

mammalou

I started on Tamoxifen 3 years ago.  Had a ct scan about 6 months in and liver was fine.  My liver enzymes started rising about 15 months ago.  This was discovered in routine blood work. They contained to rise for year before  they sent me to a liver specialist.  He determined that I now have moderate fatty liver verified by ultrasound and CT scan.   I had a blood test last week and my liver enzymes have doubled since February, so the MO is sending me back to liver doctor.  We are testing my hormones to determine if I can go off if Tamoxifen and on to an aromatase inhibitor.  I take no other drugs and don't have any of the risk factors for fatty liver so it is pretty much determined to be caused by a Tamoxifen.  I don't hiw often this happens but my MO acts like not very often.  They don't seem to want to admit that Tamoxfen does this even when it is a stated side effect in the Tamoxfen literature.